Toxicology 1

2009 Mark Tuttle

Name Mechanism Complications Contraindications Indications
Ipecac - Acts directly in small
intestine and after
absorption in
chemoreceptor
trigger zone (CTZ) in
brain
- Emesis
- Physical damage of
esophagus due to excess
omiting
- !hen chance aspiration of stomach
contents is high unless airway is
protected
- !hen regurgitation "ill exacerbate
toxicity
o #trong acids
o Petroleum distillates (chemical
pneumonitis)
- Process itself is dangerous
o $emorrhage% &' perforation
-
astric !a"age - #mall olumes of
saline infused into
stomach and
remoed by suction
- Aspiration pneumonitis
- (aryngeospasm
- )echanical in*ury to throat
- $ypothermia
- +luid electrolyte imbalance
-
#ingle dose
acti"ated
charcoal
- +ine po"ser "ith
large surface area
adsorbs many
organic molecules
and preents
absorption into body
- ,oes -.T "or/ "ith
o (i
0
% +e
10
% Pb
10
% C-
-
o )ethanol% ethanol%
sor$itol
o #trong acids2bases
- 3is/ of omiting if combined
"ith ipecac
-
Multiple%dose
acti"ated
charcoal
&M'(C)
- - 'f it diffuses bac/ into gut
- 'f it undergoes enterohepatic
cycling
- 'f long distributie phase or lo"
olume of distribution (is in blood)
*smotic !axati"e
&#or$itol)
- Pull "ater into &'
tract
- -.T adsorbed by
charcoal
- -ausea% omiting% ab cramps
- Transient hypotension
- $ypernatremia
- $ytpermagnesemia
- #trong acid or al/ali
- 'leus 4 lac/ of &' motility
- ,amaged &' tract
- 5olume depletion% hyptention%
significant electrolyte imbalance
- #"eet taste improes palatability
of charcoal
- 3arely used "ithout charcoal
#timulant
!axati"e
- - -ot useful because adsorbed by
charcoal
-
#tool #o+tener - -
,hole -owel
Irrigation
- (arge olume of
isotonic fluid 6-71 hrs
- - !hen chance aspiration of stomach
contents is high unless airway is
protected
- #trong acid or al/ali
- 'leus 4 lac/ of &' motility
- ,amaged &' tract
- &ood for slo"ly absorbed drugs
- .e
2/
ta$lets since not a$sor$ed
$y sor$itol
-iotrans+ormatio
n
- - -ot usually feasible - Can be effectie "hen the metabolite ist he toxic compound (ex methanol%
ethelyne glycol)
0emodialysis - (llows correction o+
electrolyte
- - (o" molecular "eight% "ater soluble% lo" ol of distribution
- #alicylates1 methanol1 ethylene glycol1 ethanol1 theophylline1 !i/
im$alances
0emoper+usion - - $eparin% Thrombocytopenia
- Cant correct electrolyte
- $igh molecular "eight% poor "ater solubility% high olume of distrib% bound
to protein8 2x3 4heno$ar$ital1 phenytoin1 car$ama5epine1 salicylates